Looking for patients in guidelines

Development of a search filter for identifying articles addressing patient issues

Lian Hielkema (Dutch College of General Practioners),

Monique Wessels (Dutch Association of Medical Specialists)

International Clinical Librarian Conference 2011

Birmingham, 13-14 June 2011

• Introduction• Methods• Results• Conclusion

NHG – Dutch College of

General Practitioners

Orde – Dutch Association of

Medical Specialists

Benefits of public involvement (NHS)

• better outcomes of treatment and care • a more satisfying experience for patients

of using health services• sharing responsibilities for healthcare

with the public• more appropriate use of health services

Viewpoint of our two organisations

To give patient participation a regular place in guidelines, in order to achieve a more demand-based care

by incorporating aspects of patients' perception and experience and their information needs

Methods

• Definition and scope• Construction of concept-filters• Validation database• Adaptation of concept-filters

Definition and scope (SIGN)

• experiences (condition, diagnosis, treatments, follow-up care and QoL)

• (information) needs and preferences • participation in decision-making • overall satisfaction with care received

Construction of concept-filters (for Medline via OVID and via PubMed)

Terms derived from:

- filter patient issues SIGN

- Greenhalgh, T. User involvement in health care (Wiley, 2010)

- analysis of known articles

Validation database

• guidelines SIGN• Longtin Y et al. Patient participation: current

knowledge and applicability to patient safety. Mayo Clin Proc. 2010 85(1):53-62

• guideline diabetes self-management education

Result: 176 references

Adaptation of concept-filters

• Computerized analysis of MESH-terms of articles in validation database with open source MESH-analysing apps

• Manual analysis of missed articles: – 23 (concept OVID-new filter), – 6 (concept PubMed-new filter), – 1 (OVID-SIGN filter)

Part of one of the filters (PubMed-new)• (Patient Participation[Mesh] OR consumer participation[Mesh] OR Professional-Patient Relations[Mesh] OR

Patient-Centered Care[Mesh] OR Patient Preference[Mesh] OR Patient Satisfaction[Majr] OR Patient Education as Topic[Mesh] OR Attitude to Health[Mesh] OR Patient Acceptance of Health Care[Mesh] OR Health Knowledge, Attitudes, Practice[Mesh] OR Focus Groups[Mesh] OR Quality of Life[Majr] OR Self Care[mh:noexp] OR Self Concept[Mesh] OR Self-examination[Mesh] OR Cooperative Behavior[Mesh] OR Adaptation, Psychological[Mesh] OR Decision Support Techniques[Mesh] OR Self-Help Groups[Mesh] OR Community Networks[Mesh] OR Emotions[Mesh] OR Consumer Satisfaction[Mesh] OR Needs Assessment[Mesh] OR Personal Autonomy[Mesh] OR Patient Advocacy[Mesh] OR Life Change Events[Mesh]) OR (patient perspective*[tiab] OR patient's perspective*[tiab] OR patient desire*[tiab] OR patient's desire*[tiab] OR "patient's desires"[tiab] OR patient view*[tiab] OR patient's view*[tiab] OR patient expression*[tiab] OR patient's expression*[tiab] OR patient attitude*[tiab] OR patient's attitude*[tiab] OR patient involvement*[tiab] OR patient's involvement*[tiab] OR patient decision*[tiab] OR patient's decision*[tiab] OR patient activation[tiab] OR patient's activation[tiab] OR patients activation[tiab] OR patient empowerment[tiab] OR patient participation[tiab] OR patient's participation[tiab] OR patients participation[tiab] OR patient collaboration[tiab] OR patient's collaboration[tiab] OR patients collaboration[tiab] OR expert patient*[tiab] OR consumer participation[tiab] OR consumer perspective[tiab] OR consumers perspective[tiab] ……..

Results

• Validation of concept-filters• Tables• Comparison

Validation of concept-filters

• testing in practice• 3 subjects primary care (PubMed-filter)• 3 subjects secondary care (OVID-filter)• sensitivity, specificity, precision,

accuracy

General crosstable

precision a/(a+b)

sensitivity a/(a+c)

specificity d/(b+d)

accuracy (a+d)/(a+b+c+d)

Pubmed-new:dyspepsia

precision 74.0% (53-88)

sensitivity 83.3% (62-95)

specificity 98.0% (96-99)

accuracy 92.0%

PubMed-new: BPH, chlamydia, dyspepsia

precision 79.3% (69-87)

sensitivity 90.1% (81-95)

specificity 98.8% (98-99)

accuracy 98.3%

OVID-SIGN: ICD, cataract, spina bifida

precision 21.2% (16-26)

sensitivity 98.4% (91-99)

specificity 69.1% (65-72)

accuracy 71.4%

OVID-new: ICD, cataract, spina bifida

precision 77.0% (65-86)

sensitivity 90.5% (80-96)

specificity 98.0% (96-98)

accuracy 97.0%

Comparison

Conclusions

• a never-ending story?• you can’t have it all• work in progress

Contact information

• m.wessels@orde.nl• l.hielkema@nhg.org